ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR INTERPRETATION OF THE EFAST EXAM

ARE YOU POSITIVE . . .  OR FALSE POSITIVE? IMPROVING YOUR INTERPRETATION OF THE EFAST EXAM

The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free fluid. In this post, Dr. Gill and Dr. Kring help us improve our EFAST interpretation and recognize these “fake-outs.”

Read More

Coding in the Community

Coding in the Community

Coding patients in the community setting is difficult given constraints of man power, specialists, equipment, and other resources. Knowing how to code a patient well in the community is a skill all EM practitioners should master. In this post we review the priorities and pitfalls of coding in the community, with our guest Salim Rezaie.

Read More

Beyond Burnout: Physician Depression and Suicide

Beyond Burnout: Physician Depression and Suicide

The statistics on physician suicide are frightening. Each year approximately 400 physicians commit suicide. That is more than one per day and roughly the equivalent of two entire classes of graduating medical students. Suicide accounts for 26% of deaths among physicians aged 25-39 - more than twice (11%) that of same age group in the general public. When screened, approximately 10% of medical students and physicians report current suicidal thoughts. Why are these numbers so high in the medical profession? Dr. Casey MacVane helps shed some light on this neglected crisis and what we can do to help our suffering colleagues.

Read More

Difficult Discussions - Death notification and End of Life Care

Difficult Discussions - Death notification and End of Life Care

Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century.  The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools.  In part 2 of "difficult discussions", we share our approach for two difficult patient discussions - death notification and end of life care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.

Read More

Difficult Discussions - Medical Error Disclosure and Refusal of Medical Care

Difficult Discussions - Medical Error Disclosure and Refusal of Medical Care

Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century.  The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools.  In part 1 of "difficult discussions," we share our approach for two difficult patient discussions - medical error and refusal of medical care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.

Read More

So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

So You Diagnosed Your Pediatric Patient With A Concussion… What Do You Tell The Parents Now?

In the United States an estimated 300,000 sports-related concussions occur annually. Many of these are young athletes who are referred to the emergency department for evaluation. While there are robust clinical decision aids to clarify the need for a CT brain, the literature around concussions is a bit murkier. Recently, athletes who sustained a concussion were recommended to avoid exercise and vigorous cognitive activity until their symptoms resolved entirely. Several studies over the last several years have challenged these recommendations. Dr. William Meehan is the director for the Micheli Center for Sports Injury Prevention. We were fortunate to “pick his brain” regarding questions we are often asked by the parents of the young athlete . . . when can their child return to play? When can they return to their full course work at school?

Read More

Enhancing Human Performance and Flow in Resuscitation

Enhancing Human Performance and Flow in Resuscitation

Mike Lauria was a pararescueman, providing medical/rescue support for special operations throughout the world.  Through this experience, he learned how to use psychological skills to perform under acute stress.  We were fortunate to have him join our winter symposium this year, discussing the cognitive science behind stress and performance, as well as how to use performance enhancing psychological skills for acutely stressful conditions. 

Read More

To the Cath Lab or Not? You Make the Call! - Part 2

To the Cath Lab or Not?  You Make the Call! - Part 2

Making big decisions on little information is the very nature of emergency medicine.  Nothing epitomizes this more than the decision to activate your cardiac catheterization lab for a patient with a potential ST elevation MI.  Grand Master of the squiggly lines, Dr. Sara Nelson, recently took us through a tour of several challenging chest pain patients and their respective ECG's.  Here is part two of our two part series (click here for part one).  Take a look at these cases and ask yourself, what is your initial management? What is your interpretation of the ECG  . . . do you activate the cath lab or not?.... you make the call!!

Read More